Screening Questionnaire
Please answer the following questions by clicking the appropriate button
Email address *
Your name *
Your answer
Date of birth *
Please answer the following questions by clicking on the circle *
Yes, very much
Yes, quite a bit
Not particularly
No, not at all
I don't know
Are you worried about your progress at school or work?
Do you find it easier to explain things orally than in writing?
Do you tend to misinterpret other people's body language or facial expressions?
Do you have difficulties with maths?
Do you feel that you are 'clumsy'?
Do you get numbers the wrong way around (i.e. telephone numbers)?
Do you think you are better at reading than writing?
Do you think you are able to achieve more than you can, even when you try your best?
Do you find that you learn better by listening or looking at pictures than by reading?
Do you have difficulty concentrating?
Do you tend to speak or act before you've thought about what you're about to say or do?
Do you misinterpret what people have said to you?
Do you find it difficult to memorise information?
Do you find it difficult to manage your time (for example, being on time or meeting deadlines)?
Do you misread information?
Do you copy written information down wrongly?
Do you find that you can do something right on one day, but then get it wrong on another?
Do you confuse similar looking letters (for example, mistaking 'b' for 'd')?
Do you find it difficult to keep track of which line you are reading?
Do you find it difficult to follow rows and columns in tables and charts?
Do you miss out letters and/or words when you are writing?
Do you find that you've spelled a word in different ways in one document?
Do you have difficulty remembering addresses?
Do you have difficulty following directions?
Do you think that your coordination is poor?
Is there any other information you would like to add?
Your answer
Have you ever had an assessment for learning difficulties in the past? *
If you answered yes to the question above, please give details below:
Your answer
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